The effect of corticosteroids on mortality of patients with influenza pneumonia: a systematic review and meta-analysis

Background The effect of corticosteroids on clinical outcomes in patients with influenza pneumonia remains controversial. We aimed to further evaluate the influence of corticosteroids on mortality in adult patients with influenza pneumonia by comparing corticosteroid-treated and placebo-treated pati...

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Veröffentlicht in:Critical care (London, England) Jg. 23; H. 1; S. 99 - 9
Hauptverfasser: Ni, Yue-Nan, Chen, Guo, Sun, Jiankui, Liang, Bin-Miao, Liang, Zong-An
Format: Journal Article
Sprache:Englisch
Veröffentlicht: London BioMed Central 27.03.2019
BioMed Central Ltd
Springer Nature B.V
BMC
Schlagworte:
Adrenal Cortex Hormones - standards
Adrenal Cortex Hormones - therapeutic use
Corticosteroid drugs
Corticosteroids
Critical care
Critical Care Medicine
Critically ill persons
Drug therapy
Emergency Medicine
Epstein-Barr virus
Evidence-based medicine
Glucocorticoids
Health aspects
Humans
Immunomodulators
Infections
Influenza
Influenza pneumonia
Influenza viruses
Influenza, Human - drug therapy
Influenza, Human - mortality
Intensive
Intensive care
Length of Stay
Medicine
Medicine & Public Health
Meta-analysis
Mortality
Online databases
Pandemics
Patient outcomes
Pneumonia
Pneumonia - drug therapy
Pneumonia - mortality
Respiration, Artificial - methods
Respiration, Artificial - trends
Respiratory distress syndrome
Rheumatoid arthritis
Sepsis
Software reviews
Statistics, Nonparametric
Steroids (Organic compounds)
Swine flu
Systematic review
Viral pneumonia
China
Mortality
Corticosteroids
Influenza pneumonia
ISSN:1364-8535, 1466-609X, 1364-8535, 1466-609X, 1366-609X
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Zusammenfassung:Background The effect of corticosteroids on clinical outcomes in patients with influenza pneumonia remains controversial. We aimed to further evaluate the influence of corticosteroids on mortality in adult patients with influenza pneumonia by comparing corticosteroid-treated and placebo-treated patients. Methods The PubMed, Embase, Medline, Cochrane Central Register of Controlled Trials (CENTRAL), and Information Sciences Institute (ISI) Web of Science databases were searched for all controlled studies that compared the effects of corticosteroids and placebo in adult patients with influenza pneumonia. The primary outcome was mortality, and the secondary outcomes were mechanical ventilation (MV) days, length of stay in the intensive care unit (ICU LOS), and the rate of secondary infection. Results Ten trials involving 6548 patients were pooled in our final analysis. Significant heterogeneity was found in all outcome measures except for ICU LOS ( I 2  = 38%, P  = 0.21). Compared with placebo, corticosteroids were associated with higher mortality (risk ratio [RR] 1.75, 95% confidence interval [CI] 1.30 ~ 2.36, Z  = 3.71, P  = 0.0002), longer ICU LOS (mean difference [MD] 2.14, 95% CI 1.17 ~ 3.10, Z  = 4.35, P  < 0.0001), and a higher rate of secondary infection (RR 1.98, 95% CI 1.04 ~ 3.78, Z = 2.08, P  = 0.04) but not MV days (MD 0.81, 95% CI − 1.23 ~ 2.84, Z  = 0.78, P  = 0.44) in patients with influenza pneumonia. Conclusions In patients with influenza pneumonia, corticosteroid use is associated with higher mortality. Trial registration PROSPERO (ID: CRD42018112384 ).
Bibliographie:ObjectType-Article-2
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ObjectType-Evidence Based Healthcare-1
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ISSN:1364-8535
1466-609X
1364-8535
1466-609X
1366-609X
DOI:10.1186/s13054-019-2395-8